AB0062 ANGIOTENSIN CONVERTING ENZYME ACTIVITY IN ANTI-TNF-TREATED RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS PATIENTS
Authors: B. Soós, M. Fagyas, Á. Horváth, E. Végh, A. Pusztai, M. Czókolyová, A. Csongrádi, A. Hamar, Z. Pethö, N. Bodnár, G. Kerekes, K. Hodosi, ​é. Szekanecz, S. Szamosi, S. Szántó, G. Szücs, Z. Papp, Z. Szekanecz
Journal: Annals of the Rheumatic Diseases (2022)

Background Angiotensin-converting enzyme (ACE) and ACE2 have been implicated in the regulation of vascular physiology. Elevated synovial and decreased or normal ACE or ACE2 levels have been found in rheumatoid arthritis (RA). Very little is known about the effects of tumour necrosis factor α (TNF-α) inhibition on ACE or ACE2 homeostasis. Objectives In this study, we assessed the effects of one-year anti-TNF therapy on ACE and ACE2 production in RA and ankylosing spondylitis (AS) in association with other biomarkers. Methods Forty patients including 24 RA patients treated with either etanercept (ETN) or certolizumab pegol (CZP) and 16 AS patients treated with ETN were included in a 12-month follow-up study. Serum ACE levels were determined by commercial ELISA, while serum ACE2 activity was assessed using a specific quenched fluorescent substrate. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and arterial pulse-wave velocity (PWV) in all patients. In addition, CRP, rheumatoid factor (RF) and ACPA were also measured. All assessments were performed at baseline and 6 and 12 months after treatment initiation. Results Anti-TNF therapy increased ACE levels in the full cohort, as well as in the RA and AS subsets. ACE2 activity increased in the full cohort, while the ACE/ACE2 ratio increased in the full cohort and in the RA subset (p&lt;0.05). Uni- and multivariable regression analyses determined associations between ACE or ACE/ACE2 ratios at different time points and disease duration, CRP, RF, FMD and IMT (p&lt;0.05). ACE2 activity correlated with CRP. The changes of ACE or ACE2 over 12 months were determined by treatment together with either RF or FMD (p&lt;0.05). Conclusion Anti-TNF treatment may increase ACE and ACE2 in the sera of RA and AS patients. ACE and ACE2 may be associated with disease duration, markers of inflammation and vascular pathophysiology. The effects of TNF inhibition on ACE and ACE2 may reflect, in part, the effects of these biologics on the cardiovascular system. Disclosure of Interests Boglárka Soós: None declared, Miklós Fagyas: None declared, Ágnes Horváth: None declared, Edit Végh: None declared, Anita Pusztai: None declared, Monika Czókolyová: None declared, Alexandra Csongrádi: None declared, Attila Hamar: None declared, Zsófia Pethö: None declared, Nóra Bodnár: None declared, György Kerekes: None declared, Katalin Hodosi: None declared, ​Éva Szekanecz​: None declared, Szilvia Szamosi Speakers bureau: Roche, Sager, Amgen, Sándor Szántó Speakers bureau: AbbVie, Novartis, Lilly, MSD, UCB, Consultant of: AbbVie, Novartis, UCB, Gabriella Szücs Speakers bureau: Roche, Lilly, Actelion, Zoltán Papp: None declared, Zoltán Szekanecz Speakers bureau: AbbVie, Pfizer, Roche, MSD, Novartis, Lilly, Richter, Consultant of: Pfizer, Novartis, Richter, Grant/research support from: Pfizer, UCB